Use of Cyclosporine Leads to Poorer Outcomes in Patients with Cystic Fibrosis Following Lung Transplant

Abstract

Calcineurin inhibitors, tacrolimus (TAC) and cyclosporine (CsA), are used to prevent graft rejection following transplant. In patients with cystic fibrosis (CF), in whom malabsorption and altered drug metabolism could alter the efficacy of immunosuppression, outcomes due to maintenance immunosuppression has been scantly investigated. Our aim is to assess chronic lung allograft dysfunction (CLAD) development in patients with CF who were maintained on TAC compared to CsA. The United Network Organ Sharing (UNOS) registry was queried for all patients with CF who received a primary, bilateral lung transplant between 2000- 2015. Patients were defined by calcineurin inhibitor immunosuppression at hospital discharge post-lung transplant and at 1-year post-transplant (TAC/TAC, CsA/TAC, CsA/CsA). Kaplan-Meier Survival curves with Wilcoxon test was used to test the equality of stratified survival curves. During the study period, 2207 CF patients received primary lung transplant. During the first year, TAC/TAC (81%) was most common followed by CsA/TAC (8%) and CsA/CsA (8%). CF patients on TAC/TAC were less likely to have an acute rejection episode (p<0.01). Those who received CsA during the first year post-transplant had increased CLAD development and poorer survival compared to those maintained on TAC (p<0.01) (Fig 1). Use of CsA during the first year following lung transplant led to an increased risk of CLAD and death compared to CF patients maintained on TAC during the first year following lung transplant.